Complete section of proper palmar digital pedicles: Correlation between arterial patency and sensory recovery

Wounds to proper palmar digital (PPD) pedicles are frequent surgical emergencies. A correlation between arterial patency and nerve regeneration, however, has never been demonstrated. Forty-seven patients presenting complete section of a PPD pedicle and having undergone surgical repair of both elements were followed-up at a minimum of one year postoperatively. Doppler ultrasound examination studied arterial patency as well as the degree of stenosis. Neurological examination determined the BMRC score and the existence of cold intolerance, symptomatic neuroma and neurogenic pain. In 32 cases, the artery was permeable; in the remaining 15, arterial thrombosis was identified. In 14 out of the 32 permeable-artery subjects, stenosis had no significant effect; in the remaining 18 cases, circulation was reduced. BMRC scores showed 11 S4 cases, 16 S3+, 16 S3 and 4 S2. Twenty-nine cases of intolerance to cold were identified, along with two cases of neurogenic pain and 17 cases of symptomatic neuroma. A statistically significant correlation was shown between arterial patency and BMRC scores (Chi-square, P=0.0221) and neurological symptoms appeared to be linked to the degree of stenosis. Favorable BMRC scores were observed where the artery was permeable, notably where blood flow was not modified below the repair site. This observation also seemed valid regarding disabling neurogenic symptoms.